The Problem
For the above regulations regarding PBMs to be effective, enforcement mechanisms need to be in place to monitor and ensure compliance, establish and levy penalties, and if necessary, revoke PBMs’ certification to operate within that state.
The Solution
This could easily be solved by placing PBMs under the certification authority and oversight of state insurance commissioners, who would be able to monitor PBMs’ compliance with state regulations and punish violations.
Model Legislation
Oklahoma’s 2019 Patient’s Right to Pharmacy Choice Act places responsibility for enforcing the Act with the state insurance commissioner, and provides the commissioner authority to penalize PBMs’ violations.